EFFECT OF MACROLIDE ON LUNG FUNCTION AND COMPUTED TOMOGRAPHY (CT) SCORE IN NON-CYSTIC FIBROSIS BRONCHIECTASIS

Abstract

Background: The few studies addressing the effect of macrolides in non-cystic fibrosis bronchiectasis (NCFB) range from no decline to significant improvement. There are no data evaluating macrolides on CT score.

Objectives: To retrospectively evaluate the effect of initiation of macrolides on spirometry and HRCT in a NCFB population.

Methods: We performed a word search in the electronic patient file data of the University Hospital of Leuven, Belgium, identifying all NCFB patients observed during a 41 month period and treated with macrolides. Records of all NCFB patients were manually reviewed, evaluating spirometry and CT scans, before and after/during macrolide treatment, treatment scheme, Pseudomonas status and other relevant data. CT scoring was done by using a modified version of the Brody score.

Results: Evaluation of 131 patients showed a mean FEV₁ improvement of 185 ml (p < 0.0001) or 7.7% (p < 0.0001) and a mean FVC improvement by 234 ml (p < 0.001) or 7.4% (p < 0.001). Smoking history, gender, Pseudomonas colonization and baseline lung function did not affect improvement in lung function. Patients with NCFB due to an immunodeficiency showed a significant larger macrolide-associated improvement in FEV₁% (p = 0.0075) and FVC% (p = 0.0063) than patients with NCFB due to other causes. An improvement was noted in CT subscores for bronchiectasis (p = 0.0053), mucus plugging (p = 0.0256), peribronchial thickening (p = 0.0037), parenchyma (p = 0.026) and total modified Brody score (p = 0.001) after versus before macrolide therapy.

Conclusion: Macrolides, as part of a multimodal and individualized therapy may significantly improve FVC, FEV1 and the modified Brody score in patients with NCFB, especially those with NCFB due to immunodeficiency.

Keywords:

• azithromycin
• bronchiectasis
• CT score
• lung function
• macrolide
• non-cystic fibrosis